References

2017

Imhoff, S; Malenfant, S; Nadreau, É; Poirier, P; Bailey, D M; Brassard, P

Uncoupling between cerebral perfusion and oxygenation during incremental exercise in an athlete with postconcussion syndrome: a case report Journal Article

In: Physiological Reports, vol. 5, no. 2, 2017.

Abstract | Links | BibTeX | Tags: Cerebral oxygenation, cerebral perfusion, exercise, postconcussion syndrome

2016

Blennow, K; Brody, D L; Kochanek, P M; Levin, H; McKee, A; Ribbers, G M; Yaffe, K; Zetterberg, H

Traumatic brain injuries Journal Article

In: Nature Reviews Disease Primers, vol. 2, 2016.

Abstract | Links | BibTeX | Tags: amyloid beta protein, Article, axonal injury, biological marker, BIOPHYSICS, blood, brain, BRAIN damage, cerebrospinal fluid, Chronic traumatic encephalopathy, computer assisted tomography, disease severity, endocrine disease, heredity, human, molecular pathology, neuropathology, nonhuman, nuclear magnetic resonance imaging, Pathophysiology, positron emission tomography, postconcussion syndrome, priority journal, protein aggregation, quality of life, screening, tau protein, traumatic brain injury

@article{Blennow2016,

title = {Traumatic brain injuries},

author = {Blennow, K and Brody, D L and Kochanek, P M and Levin, H and McKee, A and Ribbers, G M and Yaffe, K and Zetterberg, H},

doi = {10.1038/nrdp.2016.84},

year  = {2016},

date = {2016-01-01},

journal = {Nature Reviews Disease Primers},

volume = {2},

abstract = {Traumatic brain injuries (TBIs) are clinically grouped by severity: mild, moderate and severe. Mild TBI (the least severe form) is synonymous with concussion and is typically caused by blunt non-penetrating head trauma. The trauma causes stretching and tearing of axons, which leads to diffuse axonal injury-the best-studied pathogenetic mechanism of this disorder. However, mild TBI is defined on clinical grounds and no well-validated imaging or fluid biomarkers to determine the presence of neuronal damage in patients with mild TBI is available. Most patients with mild TBI will recover quickly, but others report persistent symptoms, called post-concussive syndrome, the underlying pathophysiology of which is largely unknown. Repeated concussive and subconcussive head injuries have been linked to the neurodegenerative condition chronic traumatic encephalopathy (CTE), which has been reported post-mortem in contact sports athletes and soldiers exposed to blasts. Insights from severe injuries and CTE plausibly shed light on the underlying cellular and molecular processes involved in mild TBI. MRI techniques and blood tests for axonal proteins to identify and grade axonal injury, in addition to PET for tau pathology, show promise as tools to explore CTE pathophysiology in longitudinal clinical studies, and might be developed into diagnostic tools for CTE. Given that CTE is attributed to repeated head trauma, prevention might be possible through rule changes by sports organizations and legislators. © 2016 Macmillan Publishers Limited, part of Springer Nature.},

keywords = {amyloid beta protein, Article, axonal injury, biological marker, BIOPHYSICS, blood, brain, BRAIN damage, cerebrospinal fluid, Chronic traumatic encephalopathy, computer assisted tomography, disease severity, endocrine disease, heredity, human, molecular pathology, neuropathology, nonhuman, nuclear magnetic resonance imaging, Pathophysiology, positron emission tomography, postconcussion syndrome, priority journal, protein aggregation, quality of life, screening, tau protein, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Holtkamp, M D; Grimes, J; Ling, G

Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article

In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.

Abstract | Links | BibTeX | Tags: apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States

@article{Holtkamp2016,

title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},

author = {Holtkamp, M D and Grimes, J and Ling, G},

doi = {10.1007/s11916-016-0572-x},

year  = {2016},

date = {2016-01-01},

journal = {Current Pain \& Headache Reports},

volume = {20},

number = {6},

abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},

keywords = {apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States},

pubstate = {published},

tppubtype = {article}

}

Naeser, M A; Martin, P I; Ho, M D; Krengel, M H; Bogdanova, Y; Knight, J A; Yee, M K; Zafonte, R; Frazier, J; Hamblin, M R; Koo, B B

Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury Journal Article

In: Photomedicine and Laser Surgery, vol. 34, no. 12, pp. 610–626, 2016.

Abstract | Links | BibTeX | Tags: Accidents, Adenosinetriphosphate, brain, Cognitive dysfunction, Diodes, Explosives, Head Injuries, Hemodynamics, Infrared devices, LED, Light, Light emitting diodes, Lightemitting diodes, LLLT, Nitric oxide, Patient monitoring, Patient treatment, PBM, Photobiomodulation, postconcussion syndrome, PTSD, Sports, Sports head injury, TBI, TBI treatment, Traumatic Brain Injuries, traumatic brain injury

@article{Naeser2016,

title = {Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury},

author = {Naeser, M A and Martin, P I and Ho, M D and Krengel, M H and Bogdanova, Y and Knight, J A and Yee, M K and Zafonte, R and Frazier, J and Hamblin, M R and Koo, B B},

doi = {10.1089/pho.2015.4037},

year  = {2016},

date = {2016-01-01},

journal = {Photomedicine and Laser Surgery},

volume = {34},

number = {12},

pages = {610--626},

abstract = {Objective: We review the general topic of traumatic brain injury (TBI) and our research utilizing transcranial photobiomodulation (tPBM) to improve cognition in chronic TBI using red/near-infrared (NIR) light-emitting diodes (LEDs) to deliver light to the head. tPBM improves mitochondrial function increasing oxygen consumption, production of adenosine triphosphate (ATP), and improving cellular energy stores. Nitric oxide is released from the cells increasing regional blood flow in the brain. Review of published studies: In our previously published study, 11 chronic TBI patients with closed-head TBI caused by different accidents (motor vehicle accident, sports-related, improvised explosive device blast injury) and exhibiting long-lasting cognitive dysfunction received 18 outpatient treatments (Monday, Wednesday, Friday for 6 weeks) starting at 10 months to 8 years post-TBI. LED therapy is nonthermal, painless, and noninvasive. An LED-based device classified as nonsignificant risk (FDA cleared) was used. Each LED cluster head (5.35 cm diameter, 500mW, 22.2 mW/cm2) was applied for 9 min 45 sec (13 J/cm2) using 11 locations on the scalp: midline from front-to-back hairline and bilaterally on frontal, parietal, and temporal areas. Testing was performed before and after transcranial LED (tLED; at 1 week, 1 month, and at 2 months after the 18th treatment) and showed significant improvements in executive function and verbal memory. There were also fewer post-traumatic stress disorder (PTSD) symptoms reported. Ongoing studies: Ongoing, current studies involve TBI patients who have been treated with tLED using either 26 J/cm2 per LED location on the head or treated with intranasal only (iLED) using red (633 nm) and NIR (810 nm) diodes placed into the nostrils. The NIR iLED is hypothesized to deliver photons to the hippocampus, and the red 633 nm iLED is believed to increase melatonin. Results have been similar to the previously published tLED study. Actigraphy sleep data showed increased time asleep (on average one additional hour per night) after the 18th tLED or iLED treatment. LED treatments may be performed in the home. Sham-controlled studies with veterans who have cognitive dysfunction from Gulf War Illness, blast TBI, and TBI/PTSD are currently ongoing. © Mary Ann Liebert, Inc.},

keywords = {Accidents, Adenosinetriphosphate, brain, Cognitive dysfunction, Diodes, Explosives, Head Injuries, Hemodynamics, Infrared devices, LED, Light, Light emitting diodes, Lightemitting diodes, LLLT, Nitric oxide, Patient monitoring, Patient treatment, PBM, Photobiomodulation, postconcussion syndrome, PTSD, Sports, Sports head injury, TBI, TBI treatment, Traumatic Brain Injuries, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Objective: We review the general topic of traumatic brain injury (TBI) and our research utilizing transcranial photobiomodulation (tPBM) to improve cognition in chronic TBI using red/near-infrared (NIR) light-emitting diodes (LEDs) to deliver light to the head. tPBM improves mitochondrial function increasing oxygen consumption, production of adenosine triphosphate (ATP), and improving cellular energy stores. Nitric oxide is released from the cells increasing regional blood flow in the brain. Review of published studies: In our previously published study, 11 chronic TBI patients with closed-head TBI caused by different accidents (motor vehicle accident, sports-related, improvised explosive device blast injury) and exhibiting long-lasting cognitive dysfunction received 18 outpatient treatments (Monday, Wednesday, Friday for 6 weeks) starting at 10 months to 8 years post-TBI. LED therapy is nonthermal, painless, and noninvasive. An LED-based device classified as nonsignificant risk (FDA cleared) was used. Each LED cluster head (5.35 cm diameter, 500mW, 22.2 mW/cm2) was applied for 9 min 45 sec (13 J/cm2) using 11 locations on the scalp: midline from front-to-back hairline and bilaterally on frontal, parietal, and temporal areas. Testing was performed before and after transcranial LED (tLED; at 1 week, 1 month, and at 2 months after the 18th treatment) and showed significant improvements in executive function and verbal memory. There were also fewer post-traumatic stress disorder (PTSD) symptoms reported. Ongoing studies: Ongoing, current studies involve TBI patients who have been treated with tLED using either 26 J/cm2 per LED location on the head or treated with intranasal only (iLED) using red (633 nm) and NIR (810 nm) diodes placed into the nostrils. The NIR iLED is hypothesized to deliver photons to the hippocampus, and the red 633 nm iLED is believed to increase melatonin. Results have been similar to the previously published tLED study. Actigraphy sleep data showed increased time asleep (on average one additional hour per night) after the 18th tLED or iLED treatment. LED treatments may be performed in the home. Sham-controlled studies with veterans who have cognitive dysfunction from Gulf War Illness, blast TBI, and TBI/PTSD are currently ongoing. © Mary Ann Liebert, Inc.

Maite, Patricia; Ne, Kathryn; Govender, Saraswathie

Reaction time deficits incurred by Cumulative Mild Head Injury (CMHI) and Post-Concussion Symptoms (PCS) between contact and non-contact sport players: A prospective study Journal Article

In: Journal of Psychology in Africa, vol. 26, no. 6, pp. 555–557, 2016, ISBN: 14330237.

Abstract | Links | BibTeX | Tags: Athletes -- Diseases, Cumulative mild head injury (CMHI), football, post-concussive symptomology (PCS), postconcussion syndrome, Symptoms, VOLLEYBALL

Hugentobler, Jason A; Gupta, Resmi; Slater, Robert; Paterno, Mark V; Riley, Michael A; Quatman-Yates, Catherine

Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 6, pp. 510–517, 2016, ISBN: 1050642X.

Abstract | BibTeX | Tags: ADOLESCENCE, AGE distribution (Demography), ATTENTION-deficit hyperactivity disorder, CORRELATION (Statistics), DATA analysis, DATA analysis -- Software, DESCRIPTIVE statistics, DISEASE complications, EQUILIBRIUM (Physiology), LONGITUDINAL method, MEDICAL history taking, MULTIPLE regression analysis, postconcussion syndrome, PROBABILITY theory, Questionnaires, SEVERITY of illness index, SEX distribution (Demography), STATISTICS

@article{Hugentobler2016,

title = {Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment},

author = {Hugentobler, Jason A and Gupta, Resmi and Slater, Robert and Paterno, Mark V and Riley, Michael A and Quatman-Yates, Catherine},

isbn = {1050642X},

year  = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {6},

pages = {510--517},

abstract = {Objective: To examine the influence of age, sex, attention-deficit hyperactivity disorder (ADHD) status, previous history of concussion, and days since injury on postconcussion postural control assessment in adolescents who have suffered a concussion. Design: Prospective cohort study. Setting: Hospital-based outpatient clinic. Participants: Seventy-one participants (42 males; 29 females) with mean age 14.14 ± 2.44. Independent Variables: Age, sex, previous concussion history, ADHD status, total and severity of postconcussion symptoms, and days since injury. Main Outcome Measures: Total Balance Error Scoring System score, path length, center-of-pressure (COP) area, sample entropy, and Romberg quotient. Results: Pearson product-moment correlation coefficients were calculated to test for potential associations between the continuous participant characteristics and the postural control variables. Spearman correlation was used to test the association between symptom severity and the postural control variables. Standard multiple regression was used to model the extent to which participant characteristics accounted for the variance in the postural sway variables. Age was significantly associated with all of the postural sway variables except COP area for the eyes open condition and sample entropy in the anterior-posterior direction for the eyes closed condition. Sex, ADHD status, and previous concussion history did not significantly predict postural control scores. Conclusions: Age significantly influences scores on common postconcussion postural control assessments. Clinical Relevance: This study demonstrates that age is a critical factor that needs to be accounted for to improve the clinical appropriateness and utility of current postconcussion postural control assessments. [ABSTRACT FROM AUTHOR]},

keywords = {ADOLESCENCE, AGE distribution (Demography), ATTENTION-deficit hyperactivity disorder, CORRELATION (Statistics), DATA analysis, DATA analysis -- Software, DESCRIPTIVE statistics, DISEASE complications, EQUILIBRIUM (Physiology), LONGITUDINAL method, MEDICAL history taking, MULTIPLE regression analysis, postconcussion syndrome, PROBABILITY theory, Questionnaires, SEVERITY of illness index, SEX distribution (Demography), STATISTICS},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article

In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma

@article{Ellis2016a,

title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},

author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},

doi = {10.3171/2015.6.JNS15972},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {125},

number = {3},

pages = {648--660},

abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},

keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},

pubstate = {published},

tppubtype = {article}

}

OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p < 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Links | BibTeX | Tags: amnesia, Article, astrocyte, athlete, Athletic Injuries, behavior change, blood vessel injury, brain, Brain Injuries, Brain Injury, cognitive defect, Concussion, confusion, degenerative disease, Epilepsy, head injury, headache, hearing impairment, human, Humans, Neck pain, nerve cell, nervous system inflammation, neurofibrillary tangle, nonhuman, Pathophysiology, postconcussion syndrome, priority journal, sport injury, traumatic brain injury, unsteadiness, Vision, wrestling

Connery, A K; Peterson, R L; Baker, D A; Randolph, C; Kirkwood, M W

The Role of Neuropsychological Evaluation in the Clinical Management of Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 475–486, 2016.

Links | BibTeX | Tags: brain concussion, childhood injury, CONVALESCENCE, health care access, health care delivery, human, medical history, mild TBI, Neuropsychological assessment, neuropsychological test, postconcussion syndrome, priority journal, return to sport, Review, risk factor, traumatic brain injury, validity

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury},

pubstate = {published},

tppubtype = {article}

}

Laker, S R; Meron, A; Greher, M R; Wilson, J

Retirement and Activity Restrictions Following Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 487–501, 2016.

Links | BibTeX | Tags: Activity restrictions, athlete, attention deficit disorder, brain concussion, Concussion, CONVALESCENCE, depression, human, learning disorder, migraine, neuropsychological test, nonhuman, PHYSICAL ACTIVITY, postconcussion syndrome, practice guideline, priority journal, Retirement, return to sport, Review, risk factor, sleep disorder, sport injury, Sport-related concussion, subarachnoid hemorrhage, symptom, traumatic brain injury, unconsciousness

Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L

Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting

@article{Silverberg2016,

title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},

author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},

doi = {10.1097/JSM.0000000000000241},

year = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {3},

pages = {226--231},

abstract = {Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting},

pubstate = {published},

tppubtype = {article}

}

Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

2015

Moran, B; Tadikonda, P; Sneed, K B; Hummel, M; Guiteau, S; Coris, E E

Postconcussive Syndrome Following Sports-related Concussion: A Treatment Overview for Primary Care Physicians Journal Article

In: Southern Medical Journal, vol. 108, no. 9, pp. 553–558, 2015.

Abstract | Links | BibTeX | Tags: alternative medicine, Amantadine, antidepressant agent, Antidepressive Agents, anxiety disorder, Article, Athletic Injuries, benzodiazepine derivative, beta adrenergic receptor blocking agent, carbamazepine, cognitive therapy, complication, Concussion, dexamphetamine, diet therapy, disease course, disease severity, Dopamine Agents, dopamine receptor stimulating agent, evidence based medicine, exercise, general practitioner, human, Humans, lamotrigine, Major Depression, METHYLPHENIDATE, monoamine oxidase inhibitor, NEUROCHEMISTRY, neuropsychological test, Pathophysiology, pharmacologic therapy, Physicians, Post-Concussion Syndrome, postconcussion syndrome, Postconcussive syndrome, Primary Care, Primary Health Care, primary medical care, rehabilitation care, rehabilitative therapy, return to sport, sport injury, sports related concussion, symptom, traumatic brain injury, tricyclic antidepressant agent, Vestibular rehabilitation, work resumption

@article{Moran2015,

title = {Postconcussive Syndrome Following Sports-related Concussion: A Treatment Overview for Primary Care Physicians},

author = {Moran, B and Tadikonda, P and Sneed, K B and Hummel, M and Guiteau, S and Coris, E E},

doi = {10.14423/SMJ.0000000000000340},

year  = {2015},

date = {2015-01-01},

journal = {Southern Medical Journal},

volume = {108},

number = {9},

pages = {553--558},

abstract = {Postconcussive syndrome is an increasingly recognized outcome of sports-related concussion (SRC), characterized by a constellation of poorly defined symptoms. Treatment of PCS is significantly different from that of SRC alone. Primary care physicians often are the first to evaluate these patients, but some are unfamiliar with the available therapeutic approaches. This review provides an overview of the pathophysiology of SRC and descriptions of both pharmacologic and nonpharmacologic treatment options to allow primary care physicians to provide evidence-based care to patients experiencing postconcussive syndrome. © 2015 by The Southern Medical Association.},

keywords = {alternative medicine, Amantadine, antidepressant agent, Antidepressive Agents, anxiety disorder, Article, Athletic Injuries, benzodiazepine derivative, beta adrenergic receptor blocking agent, carbamazepine, cognitive therapy, complication, Concussion, dexamphetamine, diet therapy, disease course, disease severity, Dopamine Agents, dopamine receptor stimulating agent, evidence based medicine, exercise, general practitioner, human, Humans, lamotrigine, Major Depression, METHYLPHENIDATE, monoamine oxidase inhibitor, NEUROCHEMISTRY, neuropsychological test, Pathophysiology, pharmacologic therapy, Physicians, Post-Concussion Syndrome, postconcussion syndrome, Postconcussive syndrome, Primary Care, Primary Health Care, primary medical care, rehabilitation care, rehabilitative therapy, return to sport, sport injury, sports related concussion, symptom, traumatic brain injury, tricyclic antidepressant agent, Vestibular rehabilitation, work resumption},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K

Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport

@article{Ellis2015,

title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},

author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},

doi = {10.3171/2015.1.PEDS14524},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery: Pediatrics},

volume = {16},

number = {3},

pages = {248--255},

abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},

keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},

pubstate = {published},

tppubtype = {article}

}

Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

Abstract | Links | BibTeX | Tags: Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed

@article{Phillips2015b,

title = {Sports-Related Traumatic Brain Injury},

author = {Phillips, S and Woessner, D},

doi = {10.1016/j.pop.2015.01.010},

year  = {2015},

date = {2015-01-01},

journal = {Primary Care - Clinics in Office Practice},

volume = {42},

number = {2},

pages = {243--248},

abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},

keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Oeur, R A; Karton, C; Post, A; Rousseau, P; Hoshizaki, T B; Marshall, S; Brien, S E; Smith, A; Cusimano, M D; Gilchrist, M D

A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma Journal Article

In: Journal of Neurosurgery, vol. 123, no. 2, pp. 415–422, 2015.

Abstract | Links | BibTeX | Tags: accident, Accident reconstruction, accidental injury, Accidents, Adolescent, adult, Article, Biomechanical Phenomena, Biomechanics, brain, brain concussion, brain stem, brain tissue, Cerebellum, clinical article, comparative study, Concussion, controlled study, Female, finite element analysis, Finite element modelling, gray matter, Hematoma, human, Humans, Hybrid iii headform, injury severity, laboratory test, Male, Mechanical, mechanical stress, middle aged, pathology, Pathophysiology, Persistent postconcussive symptoms, PHYSIOLOGY, Post Hoc Analysis, Post-Concussion Syndrome, postconcussion syndrome, priority journal, shear stress, simulation, SPORTS medicine, STATISTICAL significance, Stress, stress strain relationship, Subdural, subdural hematoma, traumatic brain injury, white matter, Young Adult

@article{Oeur2015,

title = {A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma},

author = {Oeur, R A and Karton, C and Post, A and Rousseau, P and Hoshizaki, T B and Marshall, S and Brien, S E and Smith, A and Cusimano, M D and Gilchrist, M D},

doi = {10.3171/2014.10.JNS14440},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery},

volume = {123},

number = {2},

pages = {415--422},

abstract = {Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p \< 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p \< 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.},

keywords = {accident, Accident reconstruction, accidental injury, Accidents, Adolescent, adult, Article, Biomechanical Phenomena, Biomechanics, brain, brain concussion, brain stem, brain tissue, Cerebellum, clinical article, comparative study, Concussion, controlled study, Female, finite element analysis, Finite element modelling, gray matter, Hematoma, human, Humans, Hybrid iii headform, injury severity, laboratory test, Male, Mechanical, mechanical stress, middle aged, pathology, Pathophysiology, Persistent postconcussive symptoms, PHYSIOLOGY, Post Hoc Analysis, Post-Concussion Syndrome, postconcussion syndrome, priority journal, shear stress, simulation, SPORTS medicine, STATISTICAL significance, Stress, stress strain relationship, Subdural, subdural hematoma, traumatic brain injury, white matter, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p < 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p < 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.

Dessy, A M; Rasouli, J; Choudhri, T F

Second Impact Syndrome: A Rare, Devastating Consequence of Repetitive Head Injuries Journal Article

In: Neurosurgery Quarterly, vol. 25, no. 3, pp. 423–426, 2015.

Abstract | Links | BibTeX | Tags: Article, brain concussion, clinical feature, Concussion, Dizziness, fatigue, headache, human, hyperemia, intracranial hypertension, memory disorder, Neck pain, neuropathology, neurosurgeon, neurosurgery, Pathophysiology, postconcussion syndrome, priority journal, respiratory failure, Second impact syndrome, sport injury, traumatic brain injury

Vassilyadi, M; Macartney, G; Barrowman, N; Anderson, P; Dube, K

Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study Journal Article

In: Pediatric Neurosurgery, vol. 50, no. 4, pp. 196–203, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, adult, affect, Article, Athletic Injuries, behavior disorder, brain concussion, Child, clinical article, clinical assessment, cognitive defect, Cognitive Efficiency Index, complication, Concussion, Concussion Symptom Scale, controlled study, Craniocerebral Trauma, Cross-Sectional Studies, cross-sectional study, fatigue, Female, head injury, headache, human, Humans, Immediate Postconcussion Assessment and Cognitive, Likert scale, Male, memory disorder, mild traumatic brain injury, neuropsychological test, noise, Paediatric patients, Pediatric Quality of Life Inventory, postconcussion syndrome, priority journal, psychology, quality of life, rating scale, scoring system, Sport, sport injury, Sports, symptom, time factor, Time Factors, traumatic brain injury, trends

@article{Vassilyadi2015,

title = {Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study},

author = {Vassilyadi, M and Macartney, G and Barrowman, N and Anderson, P and Dube, K},

doi = {10.1159/000431232},

year  = {2015},

date = {2015-01-01},

journal = {Pediatric Neurosurgery},

volume = {50},

number = {4},

pages = {196--203},

abstract = {Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p \< 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities. © 2015 S. Karger AG, Basel.},

keywords = {Adolescent, adult, affect, Article, Athletic Injuries, behavior disorder, brain concussion, Child, clinical article, clinical assessment, cognitive defect, Cognitive Efficiency Index, complication, Concussion, Concussion Symptom Scale, controlled study, Craniocerebral Trauma, Cross-Sectional Studies, cross-sectional study, fatigue, Female, head injury, headache, human, Humans, Immediate Postconcussion Assessment and Cognitive, Likert scale, Male, memory disorder, mild traumatic brain injury, neuropsychological test, noise, Paediatric patients, Pediatric Quality of Life Inventory, postconcussion syndrome, priority journal, psychology, quality of life, rating scale, scoring system, Sport, sport injury, Sports, symptom, time factor, Time Factors, traumatic brain injury, trends},

pubstate = {published},

tppubtype = {article}

}

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W

Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article

In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.

Abstract | BibTeX | Tags: *BRAIN -- Concussion, *BRAIN -- Wounds & injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS

@article{Dematteo2015b,

title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},

author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},

isbn = {01959131},

year  = {2015},

date = {2015-01-01},

journal = {Medicine \& Science in Sports \& Exercise},

volume = {47},

number = {11},

pages = {2283--2290},

abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},

keywords = {*BRAIN -- Concussion, *BRAIN -- Wounds \&amp; injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS},

pubstate = {published},

tppubtype = {article}

}

De Matteo, C; Volterman, K A; Breithaupt, P G; Claridge, E A; Adamich, J; Timmons, B W

Exertion testing in youth with mild traumatic brain injury/concussion Journal Article

In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors

@article{DeMatteo2015,

title = {Exertion testing in youth with mild traumatic brain injury/concussion},

author = {{De Matteo}, C and Volterman, K A and Breithaupt, P G and Claridge, E A and Adamich, J and Timmons, B W},

doi = {10.1249/MSS.0000000000000682},

year  = {2015},

date = {2015-01-01},

journal = {Medicine \& Science in Sports \& Exercise},

volume = {47},

number = {11},

pages = {2283--2290},

abstract = {Purpose The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. © 2015 by the American College of Sports Medicine.},

keywords = {Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors},

pubstate = {published},

tppubtype = {article}

}

Lucas, S

Posttraumatic Headache: Clinical Characterization and Management Journal Article

In: Current Pain & Headache Reports, vol. 19, no. 10, 2015.

Abstract | Links | BibTeX | Tags: amitriptyline, botulinum toxin A, Brain Injuries, chiropractic, clinical feature, complication, Concussion, diagnostic approach route, disease association, disease classification, disease predisposition, drug efficacy, drug induced headache, evidence based medicine, human, Humans, migraine, neuropsychological test, Neuropsychological Tests, nonsteroid antiinflammatory agent, paracetamol, physiotherapy, Post-traumatic headache, postconcussion syndrome, posttraumatic headache, practice guideline, Prevalence, primary headache, Review, risk factor, Risk Factors, SEVERITY of illness index, sports concussion, symptomatology, tension headache, Tension-type headache, topiramate, traumatic brain injury, treatment response, UNITED States, valproate semisodium

@article{Lucas2015,

title = {Posttraumatic Headache: Clinical Characterization and Management},

author = {Lucas, S},

doi = {10.1007/s11916-015-0520-1},

year  = {2015},

date = {2015-01-01},

journal = {Current Pain \& Headache Reports},

volume = {19},

number = {10},

abstract = {Headache is the most common symptom after traumatic brain injury (TBI). TBI has become a global health concern with an estimated 2.5 million reported TBIs per year in the USA alone. Recent longitudinal studies of posttraumatic headache (PTH) show a high cumulative incidence of 71 % after moderate or severe TBI and an even higher cumulative incidence of 91 % after mild TBI (mTBI) at 1 year after injury. Prevalence remains high at over 44 % throughout the year after moderate or severe TBI and over 54 % after mTBI. A prior history of headache is associated with a higher risk for PTH, whereas older age appears to be protective. Gender does not appear to be a risk factor for PTH. Most PTH has clinical diagnostic criteria meeting that of migraine or probable migraine when primary headache disorder classification criteria are used, followed by tension-type headache. There are no evidence-based treatment guidelines for PTH management; however, expert opinion has suggested treating the PTH using primary headache disorder treatment recommendations according to its type. © 2015, Springer Science+Business Media New York.},

keywords = {amitriptyline, botulinum toxin A, Brain Injuries, chiropractic, clinical feature, complication, Concussion, diagnostic approach route, disease association, disease classification, disease predisposition, drug efficacy, drug induced headache, evidence based medicine, human, Humans, migraine, neuropsychological test, Neuropsychological Tests, nonsteroid antiinflammatory agent, paracetamol, physiotherapy, Post-traumatic headache, postconcussion syndrome, posttraumatic headache, practice guideline, Prevalence, primary headache, Review, risk factor, Risk Factors, SEVERITY of illness index, sports concussion, symptomatology, tension headache, Tension-type headache, topiramate, traumatic brain injury, treatment response, UNITED States, valproate semisodium},

pubstate = {published},

tppubtype = {article}

}

2014

Antonius, D; Mathew, N; Picano, J; Hinds, A; Cogswell, A; Olympia, J; Brooks, T; Di Giacomo, M; Baker, J; Willer, B; Leddy, J

Behavioral health symptoms associated with chronic traumatic encephalopathy: A critical review of the literature and recommendations for treatment and research Journal Article

In: Journal of Neuropsychiatry and Clinical Neurosciences, vol. 26, no. 4, pp. 313–322, 2014.

Abstract | Links | BibTeX | Tags: Aggression, anxiety disorder, apathy, Article, behavior change, behavior disorder, brain concussion, buspirone, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy beta adrenergic r, cingulate gyrus, degenerative disease, depression, euphoria, head injury, human, hypersexuality, impulse control disorder, mental disease, mental instability, mood change, nerve degeneration, neurofibrillary tangle, olanzapine, parahippocampal gyrus, personality disorder, postconcussion syndrome, posttraumatic stress disorder, priority journal, serotonin uptake inhibitor, sexual behavior, suicidal behavior, traumatic brain injury

@article{Antonius2014,

title = {Behavioral health symptoms associated with chronic traumatic encephalopathy: A critical review of the literature and recommendations for treatment and research},

author = {Antonius, D and Mathew, N and Picano, J and Hinds, A and Cogswell, A and Olympia, J and Brooks, T and {Di Giacomo}, M and Baker, J and Willer, B and Leddy, J},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84920996232\&partnerID=40\&md5=cb8a1deab38101900f8d7a8ac0b7a80c},

year  = {2014},

date = {2014-01-01},

journal = {Journal of Neuropsychiatry and Clinical Neurosciences},

volume = {26},

number = {4},

pages = {313--322},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurodegenerative syndrome that has been linked to serious psychiatric symptoms, including depression, aggression, and suicidal behavior. This review critically examines the extant research on the behavioral manifestations of CTE and concludes that the paucity of longitudinal prospective studies on CTE, combined with a lack of research-accepted diagnostic criteria for identifying individuals who are considered at risk for CTE, makes it difficult to reliably establish a causal relationship between CTE and the onset of behavioral health problems. Selection and reporting bias and inconsistency in data collection methods are other concerns. To advance the field, there is a critical need for more empirical research on the behavioral manifestations of CTE. Recommendations and intervention models are also discussed. © 2014 American Psychiatric Association.},

keywords = {Aggression, anxiety disorder, apathy, Article, behavior change, behavior disorder, brain concussion, buspirone, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy beta adrenergic r, cingulate gyrus, degenerative disease, depression, euphoria, head injury, human, hypersexuality, impulse control disorder, mental disease, mental instability, mood change, nerve degeneration, neurofibrillary tangle, olanzapine, parahippocampal gyrus, personality disorder, postconcussion syndrome, posttraumatic stress disorder, priority journal, serotonin uptake inhibitor, sexual behavior, suicidal behavior, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Jordan, B D

Chronic traumatic encephalopathy and other long-term sequelae Journal Article

In: CONTINUUM Lifelong Learning in Neurology, vol. 20, pp. 1588–1604, 2014.

Abstract | Links | BibTeX | Tags: Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury

@article{Jordan2014,

title = {Chronic traumatic encephalopathy and other long-term sequelae},

author = {Jordan, B D},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84927562326\&partnerID=40\&md5=da8cab7e63cee5fa58ae148fa7de9dec},

year  = {2014},

date = {2014-01-01},

journal = {CONTINUUM Lifelong Learning in Neurology},

volume = {20},

pages = {1588--1604},

abstract = {Purpose of Review: Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. Recent Findings: CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. Summary: This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports. © 2014, American Academy of Neurology.},

keywords = {Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

2012

Jarvie, Amber

Educate to Prevent: A Look at Concussion Prevention Journal Article

In: UBC Medical Journal, vol. 3, no. 2, pp. 52, 2012, ISBN: 19207425.

Abstract | BibTeX | Tags: BRAIN -- Concussion, BRAIN -- Wounds & injuries, Epilepsy, Physicians -- Training of, postconcussion syndrome

2007

Kerr, J; Swann, I J; Pentland, B

A survey of information given to head-injured patients on direct discharge from emergency departments in Scotland Journal Article

In: Emergency Medicine Journal, vol. 24, no. 5, pp. 330–332, 2007, ISBN: 1472-0205.

Abstract | Links | BibTeX | Tags: adult, Child, Emergency Service, Head Injuries, human, Pamphlets, Patient Discharge Education -- Evaluation, postconcussion syndrome, Scotland

Reference Search

26 entries « ‹ 1 of 2 › »

Imhoff, S; Malenfant, S; Nadreau, É; Poirier, P; Bailey, D M; Brassard, P

Uncoupling between cerebral perfusion and oxygenation during incremental exercise in an athlete with postconcussion syndrome: a case report Journal Article

In: Physiological Reports, vol. 5, no. 2, 2017.

Abstract | Links | BibTeX

Blennow, K; Brody, D L; Kochanek, P M; Levin, H; McKee, A; Ribbers, G M; Yaffe, K; Zetterberg, H

Traumatic brain injuries Journal Article

In: Nature Reviews Disease Primers, vol. 2, 2016.

Abstract | Links | BibTeX

Holtkamp, M D; Grimes, J; Ling, G

Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article

In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.

Abstract | Links | BibTeX

@article{Holtkamp2016,

title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},

author = {Holtkamp, M D and Grimes, J and Ling, G},

doi = {10.1007/s11916-016-0572-x},

year  = {2016},

date = {2016-01-01},

journal = {Current Pain \& Headache Reports},

volume = {20},

number = {6},

abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Naeser, M A; Martin, P I; Ho, M D; Krengel, M H; Bogdanova, Y; Knight, J A; Yee, M K; Zafonte, R; Frazier, J; Hamblin, M R; Koo, B B

Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury Journal Article

In: Photomedicine and Laser Surgery, vol. 34, no. 12, pp. 610–626, 2016.

Abstract | Links | BibTeX

@article{Naeser2016,

title = {Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury},

author = {Naeser, M A and Martin, P I and Ho, M D and Krengel, M H and Bogdanova, Y and Knight, J A and Yee, M K and Zafonte, R and Frazier, J and Hamblin, M R and Koo, B B},

doi = {10.1089/pho.2015.4037},

year  = {2016},

date = {2016-01-01},

journal = {Photomedicine and Laser Surgery},

volume = {34},

number = {12},

pages = {610--626},

abstract = {Objective: We review the general topic of traumatic brain injury (TBI) and our research utilizing transcranial photobiomodulation (tPBM) to improve cognition in chronic TBI using red/near-infrared (NIR) light-emitting diodes (LEDs) to deliver light to the head. tPBM improves mitochondrial function increasing oxygen consumption, production of adenosine triphosphate (ATP), and improving cellular energy stores. Nitric oxide is released from the cells increasing regional blood flow in the brain. Review of published studies: In our previously published study, 11 chronic TBI patients with closed-head TBI caused by different accidents (motor vehicle accident, sports-related, improvised explosive device blast injury) and exhibiting long-lasting cognitive dysfunction received 18 outpatient treatments (Monday, Wednesday, Friday for 6 weeks) starting at 10 months to 8 years post-TBI. LED therapy is nonthermal, painless, and noninvasive. An LED-based device classified as nonsignificant risk (FDA cleared) was used. Each LED cluster head (5.35 cm diameter, 500mW, 22.2 mW/cm2) was applied for 9 min 45 sec (13 J/cm2) using 11 locations on the scalp: midline from front-to-back hairline and bilaterally on frontal, parietal, and temporal areas. Testing was performed before and after transcranial LED (tLED; at 1 week, 1 month, and at 2 months after the 18th treatment) and showed significant improvements in executive function and verbal memory. There were also fewer post-traumatic stress disorder (PTSD) symptoms reported. Ongoing studies: Ongoing, current studies involve TBI patients who have been treated with tLED using either 26 J/cm2 per LED location on the head or treated with intranasal only (iLED) using red (633 nm) and NIR (810 nm) diodes placed into the nostrils. The NIR iLED is hypothesized to deliver photons to the hippocampus, and the red 633 nm iLED is believed to increase melatonin. Results have been similar to the previously published tLED study. Actigraphy sleep data showed increased time asleep (on average one additional hour per night) after the 18th tLED or iLED treatment. LED treatments may be performed in the home. Sham-controlled studies with veterans who have cognitive dysfunction from Gulf War Illness, blast TBI, and TBI/PTSD are currently ongoing. © Mary Ann Liebert, Inc.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Maite, Patricia; Ne, Kathryn; Govender, Saraswathie

Reaction time deficits incurred by Cumulative Mild Head Injury (CMHI) and Post-Concussion Symptoms (PCS) between contact and non-contact sport players: A prospective study Journal Article

In: Journal of Psychology in Africa, vol. 26, no. 6, pp. 555–557, 2016, ISBN: 14330237.

Abstract | Links | BibTeX

Hugentobler, Jason A; Gupta, Resmi; Slater, Robert; Paterno, Mark V; Riley, Michael A; Quatman-Yates, Catherine

Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 6, pp. 510–517, 2016, ISBN: 1050642X.

Abstract | BibTeX

@article{Hugentobler2016,

title = {Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment},

author = {Hugentobler, Jason A and Gupta, Resmi and Slater, Robert and Paterno, Mark V and Riley, Michael A and Quatman-Yates, Catherine},

isbn = {1050642X},

year  = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {6},

pages = {510--517},

abstract = {Objective: To examine the influence of age, sex, attention-deficit hyperactivity disorder (ADHD) status, previous history of concussion, and days since injury on postconcussion postural control assessment in adolescents who have suffered a concussion. Design: Prospective cohort study. Setting: Hospital-based outpatient clinic. Participants: Seventy-one participants (42 males; 29 females) with mean age 14.14 ± 2.44. Independent Variables: Age, sex, previous concussion history, ADHD status, total and severity of postconcussion symptoms, and days since injury. Main Outcome Measures: Total Balance Error Scoring System score, path length, center-of-pressure (COP) area, sample entropy, and Romberg quotient. Results: Pearson product-moment correlation coefficients were calculated to test for potential associations between the continuous participant characteristics and the postural control variables. Spearman correlation was used to test the association between symptom severity and the postural control variables. Standard multiple regression was used to model the extent to which participant characteristics accounted for the variance in the postural sway variables. Age was significantly associated with all of the postural sway variables except COP area for the eyes open condition and sample entropy in the anterior-posterior direction for the eyes closed condition. Sex, ADHD status, and previous concussion history did not significantly predict postural control scores. Conclusions: Age significantly influences scores on common postconcussion postural control assessments. Clinical Relevance: This study demonstrates that age is a critical factor that needs to be accounted for to improve the clinical appropriateness and utility of current postconcussion postural control assessments. [ABSTRACT FROM AUTHOR]},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article

In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.

Abstract | Links | BibTeX

@article{Ellis2016a,

title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},

author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},

doi = {10.3171/2015.6.JNS15972},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {125},

number = {3},

pages = {648--660},

abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Links | BibTeX

Connery, A K; Peterson, R L; Baker, D A; Randolph, C; Kirkwood, M W

The Role of Neuropsychological Evaluation in the Clinical Management of Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 475–486, 2016.

Links | BibTeX

10.

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

Abstract | Links | BibTeX

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

11.

Laker, S R; Meron, A; Greher, M R; Wilson, J

Retirement and Activity Restrictions Following Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 487–501, 2016.

Links | BibTeX

12.

Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L

Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.

Abstract | Links | BibTeX

@article{Silverberg2016,

title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},

author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},

doi = {10.1097/JSM.0000000000000241},

year  = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {3},

pages = {226--231},

abstract = {Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

13.

Moran, B; Tadikonda, P; Sneed, K B; Hummel, M; Guiteau, S; Coris, E E

Postconcussive Syndrome Following Sports-related Concussion: A Treatment Overview for Primary Care Physicians Journal Article

In: Southern Medical Journal, vol. 108, no. 9, pp. 553–558, 2015.

Abstract | Links | BibTeX

14.

Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K

Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.

Abstract | Links | BibTeX

@article{Ellis2015,

title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},

author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},

doi = {10.3171/2015.1.PEDS14524},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery: Pediatrics},

volume = {16},

number = {3},

pages = {248--255},

abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

15.

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

Abstract | Links | BibTeX

16.

Oeur, R A; Karton, C; Post, A; Rousseau, P; Hoshizaki, T B; Marshall, S; Brien, S E; Smith, A; Cusimano, M D; Gilchrist, M D

In: Journal of Neurosurgery, vol. 123, no. 2, pp. 415–422, 2015.

Abstract | Links | BibTeX

@article{Oeur2015,

title = {A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma},

author = {Oeur, R A and Karton, C and Post, A and Rousseau, P and Hoshizaki, T B and Marshall, S and Brien, S E and Smith, A and Cusimano, M D and Gilchrist, M D},

doi = {10.3171/2014.10.JNS14440},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery},

volume = {123},

number = {2},

pages = {415--422},

abstract = {Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p \< 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p \< 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

17.

Dessy, A M; Rasouli, J; Choudhri, T F

Second Impact Syndrome: A Rare, Devastating Consequence of Repetitive Head Injuries Journal Article

In: Neurosurgery Quarterly, vol. 25, no. 3, pp. 423–426, 2015.

Abstract | Links | BibTeX

18.

Vassilyadi, M; Macartney, G; Barrowman, N; Anderson, P; Dube, K

Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study Journal Article

In: Pediatric Neurosurgery, vol. 50, no. 4, pp. 196–203, 2015.

Abstract | Links | BibTeX

@article{Vassilyadi2015,

title = {Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study},

author = {Vassilyadi, M and Macartney, G and Barrowman, N and Anderson, P and Dube, K},

doi = {10.1159/000431232},

year  = {2015},

date = {2015-01-01},

journal = {Pediatric Neurosurgery},

volume = {50},

number = {4},

pages = {196--203},

abstract = {Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p \< 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities. © 2015 S. Karger AG, Basel.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

19.

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

20.

Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W

Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article

In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.

Abstract | BibTeX

@article{Dematteo2015b,

title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},

author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},

isbn = {01959131},

year  = {2015},

date = {2015-01-01},

journal = {Medicine \& Science in Sports \& Exercise},

volume = {47},

number = {11},

pages = {2283--2290},

abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

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2017

Imhoff, S; Malenfant, S; Nadreau, É; Poirier, P; Bailey, D M; Brassard, P

Uncoupling between cerebral perfusion and oxygenation during incremental exercise in an athlete with postconcussion syndrome: a case report Journal Article

In: Physiological Reports, vol. 5, no. 2, 2017.

Abstract | Links | BibTeX | Tags: Cerebral oxygenation, cerebral perfusion, exercise, postconcussion syndrome

2016

Blennow, K; Brody, D L; Kochanek, P M; Levin, H; McKee, A; Ribbers, G M; Yaffe, K; Zetterberg, H

Traumatic brain injuries Journal Article

In: Nature Reviews Disease Primers, vol. 2, 2016.

@article{Blennow2016,

title = {Traumatic brain injuries},

author = {Blennow, K and Brody, D L and Kochanek, P M and Levin, H and McKee, A and Ribbers, G M and Yaffe, K and Zetterberg, H},

doi = {10.1038/nrdp.2016.84},

year  = {2016},

date = {2016-01-01},

journal = {Nature Reviews Disease Primers},

volume = {2},

abstract = {Traumatic brain injuries (TBIs) are clinically grouped by severity: mild, moderate and severe. Mild TBI (the least severe form) is synonymous with concussion and is typically caused by blunt non-penetrating head trauma. The trauma causes stretching and tearing of axons, which leads to diffuse axonal injury-the best-studied pathogenetic mechanism of this disorder. However, mild TBI is defined on clinical grounds and no well-validated imaging or fluid biomarkers to determine the presence of neuronal damage in patients with mild TBI is available. Most patients with mild TBI will recover quickly, but others report persistent symptoms, called post-concussive syndrome, the underlying pathophysiology of which is largely unknown. Repeated concussive and subconcussive head injuries have been linked to the neurodegenerative condition chronic traumatic encephalopathy (CTE), which has been reported post-mortem in contact sports athletes and soldiers exposed to blasts. Insights from severe injuries and CTE plausibly shed light on the underlying cellular and molecular processes involved in mild TBI. MRI techniques and blood tests for axonal proteins to identify and grade axonal injury, in addition to PET for tau pathology, show promise as tools to explore CTE pathophysiology in longitudinal clinical studies, and might be developed into diagnostic tools for CTE. Given that CTE is attributed to repeated head trauma, prevention might be possible through rule changes by sports organizations and legislators. © 2016 Macmillan Publishers Limited, part of Springer Nature.},

keywords = {amyloid beta protein, Article, axonal injury, biological marker, BIOPHYSICS, blood, brain, BRAIN damage, cerebrospinal fluid, Chronic traumatic encephalopathy, computer assisted tomography, disease severity, endocrine disease, heredity, human, molecular pathology, neuropathology, nonhuman, nuclear magnetic resonance imaging, Pathophysiology, positron emission tomography, postconcussion syndrome, priority journal, protein aggregation, quality of life, screening, tau protein, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Holtkamp, M D; Grimes, J; Ling, G

Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article

In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.

@article{Holtkamp2016,

title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},

author = {Holtkamp, M D and Grimes, J and Ling, G},

doi = {10.1007/s11916-016-0572-x},

year  = {2016},

date = {2016-01-01},

journal = {Current Pain \& Headache Reports},

volume = {20},

number = {6},

abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},

keywords = {apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States},

pubstate = {published},

tppubtype = {article}

}

Naeser, M A; Martin, P I; Ho, M D; Krengel, M H; Bogdanova, Y; Knight, J A; Yee, M K; Zafonte, R; Frazier, J; Hamblin, M R; Koo, B B

Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury Journal Article

In: Photomedicine and Laser Surgery, vol. 34, no. 12, pp. 610–626, 2016.

@article{Naeser2016,

title = {Transcranial, red/near-infrared light-emitting diode therapy to improve cognition in chronic traumatic brain injury},

author = {Naeser, M A and Martin, P I and Ho, M D and Krengel, M H and Bogdanova, Y and Knight, J A and Yee, M K and Zafonte, R and Frazier, J and Hamblin, M R and Koo, B B},

doi = {10.1089/pho.2015.4037},

year  = {2016},

date = {2016-01-01},

journal = {Photomedicine and Laser Surgery},

volume = {34},

number = {12},

pages = {610--626},

abstract = {Objective: We review the general topic of traumatic brain injury (TBI) and our research utilizing transcranial photobiomodulation (tPBM) to improve cognition in chronic TBI using red/near-infrared (NIR) light-emitting diodes (LEDs) to deliver light to the head. tPBM improves mitochondrial function increasing oxygen consumption, production of adenosine triphosphate (ATP), and improving cellular energy stores. Nitric oxide is released from the cells increasing regional blood flow in the brain. Review of published studies: In our previously published study, 11 chronic TBI patients with closed-head TBI caused by different accidents (motor vehicle accident, sports-related, improvised explosive device blast injury) and exhibiting long-lasting cognitive dysfunction received 18 outpatient treatments (Monday, Wednesday, Friday for 6 weeks) starting at 10 months to 8 years post-TBI. LED therapy is nonthermal, painless, and noninvasive. An LED-based device classified as nonsignificant risk (FDA cleared) was used. Each LED cluster head (5.35 cm diameter, 500mW, 22.2 mW/cm2) was applied for 9 min 45 sec (13 J/cm2) using 11 locations on the scalp: midline from front-to-back hairline and bilaterally on frontal, parietal, and temporal areas. Testing was performed before and after transcranial LED (tLED; at 1 week, 1 month, and at 2 months after the 18th treatment) and showed significant improvements in executive function and verbal memory. There were also fewer post-traumatic stress disorder (PTSD) symptoms reported. Ongoing studies: Ongoing, current studies involve TBI patients who have been treated with tLED using either 26 J/cm2 per LED location on the head or treated with intranasal only (iLED) using red (633 nm) and NIR (810 nm) diodes placed into the nostrils. The NIR iLED is hypothesized to deliver photons to the hippocampus, and the red 633 nm iLED is believed to increase melatonin. Results have been similar to the previously published tLED study. Actigraphy sleep data showed increased time asleep (on average one additional hour per night) after the 18th tLED or iLED treatment. LED treatments may be performed in the home. Sham-controlled studies with veterans who have cognitive dysfunction from Gulf War Illness, blast TBI, and TBI/PTSD are currently ongoing. © Mary Ann Liebert, Inc.},

keywords = {Accidents, Adenosinetriphosphate, brain, Cognitive dysfunction, Diodes, Explosives, Head Injuries, Hemodynamics, Infrared devices, LED, Light, Light emitting diodes, Lightemitting diodes, LLLT, Nitric oxide, Patient monitoring, Patient treatment, PBM, Photobiomodulation, postconcussion syndrome, PTSD, Sports, Sports head injury, TBI, TBI treatment, Traumatic Brain Injuries, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Maite, Patricia; Ne, Kathryn; Govender, Saraswathie

Reaction time deficits incurred by Cumulative Mild Head Injury (CMHI) and Post-Concussion Symptoms (PCS) between contact and non-contact sport players: A prospective study Journal Article

In: Journal of Psychology in Africa, vol. 26, no. 6, pp. 555–557, 2016, ISBN: 14330237.

Abstract | Links | BibTeX | Tags: Athletes -- Diseases, Cumulative mild head injury (CMHI), football, post-concussive symptomology (PCS), postconcussion syndrome, Symptoms, VOLLEYBALL

Hugentobler, Jason A; Gupta, Resmi; Slater, Robert; Paterno, Mark V; Riley, Michael A; Quatman-Yates, Catherine

Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 6, pp. 510–517, 2016, ISBN: 1050642X.

@article{Hugentobler2016,

title = {Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment},

author = {Hugentobler, Jason A and Gupta, Resmi and Slater, Robert and Paterno, Mark V and Riley, Michael A and Quatman-Yates, Catherine},

isbn = {1050642X},

year  = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {6},

pages = {510--517},

abstract = {Objective: To examine the influence of age, sex, attention-deficit hyperactivity disorder (ADHD) status, previous history of concussion, and days since injury on postconcussion postural control assessment in adolescents who have suffered a concussion. Design: Prospective cohort study. Setting: Hospital-based outpatient clinic. Participants: Seventy-one participants (42 males; 29 females) with mean age 14.14 ± 2.44. Independent Variables: Age, sex, previous concussion history, ADHD status, total and severity of postconcussion symptoms, and days since injury. Main Outcome Measures: Total Balance Error Scoring System score, path length, center-of-pressure (COP) area, sample entropy, and Romberg quotient. Results: Pearson product-moment correlation coefficients were calculated to test for potential associations between the continuous participant characteristics and the postural control variables. Spearman correlation was used to test the association between symptom severity and the postural control variables. Standard multiple regression was used to model the extent to which participant characteristics accounted for the variance in the postural sway variables. Age was significantly associated with all of the postural sway variables except COP area for the eyes open condition and sample entropy in the anterior-posterior direction for the eyes closed condition. Sex, ADHD status, and previous concussion history did not significantly predict postural control scores. Conclusions: Age significantly influences scores on common postconcussion postural control assessments. Clinical Relevance: This study demonstrates that age is a critical factor that needs to be accounted for to improve the clinical appropriateness and utility of current postconcussion postural control assessments. [ABSTRACT FROM AUTHOR]},

keywords = {ADOLESCENCE, AGE distribution (Demography), ATTENTION-deficit hyperactivity disorder, CORRELATION (Statistics), DATA analysis, DATA analysis -- Software, DESCRIPTIVE statistics, DISEASE complications, EQUILIBRIUM (Physiology), LONGITUDINAL method, MEDICAL history taking, MULTIPLE regression analysis, postconcussion syndrome, PROBABILITY theory, Questionnaires, SEVERITY of illness index, SEX distribution (Demography), STATISTICS},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article

In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma

@article{Ellis2016a,

title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},

author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},

doi = {10.3171/2015.6.JNS15972},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {125},

number = {3},

pages = {648--660},

abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},

keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},

pubstate = {published},

tppubtype = {article}

}

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Connery, A K; Peterson, R L; Baker, D A; Randolph, C; Kirkwood, M W

The Role of Neuropsychological Evaluation in the Clinical Management of Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 475–486, 2016.

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury},

pubstate = {published},

tppubtype = {article}

}

Laker, S R; Meron, A; Greher, M R; Wilson, J

Retirement and Activity Restrictions Following Concussion Journal Article

In: Physical Medicine & Rehabilitation Clinics of North America, vol. 27, no. 2, pp. 487–501, 2016.

Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L

Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article

In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.

@article{Silverberg2016,

title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},

author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},

doi = {10.1097/JSM.0000000000000241},

year = {2016},

date = {2016-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {26},

number = {3},

pages = {226--231},

pubstate = {published},

tppubtype = {article}

}

2015

Moran, B; Tadikonda, P; Sneed, K B; Hummel, M; Guiteau, S; Coris, E E

Postconcussive Syndrome Following Sports-related Concussion: A Treatment Overview for Primary Care Physicians Journal Article

In: Southern Medical Journal, vol. 108, no. 9, pp. 553–558, 2015.

@article{Moran2015,

title = {Postconcussive Syndrome Following Sports-related Concussion: A Treatment Overview for Primary Care Physicians},

author = {Moran, B and Tadikonda, P and Sneed, K B and Hummel, M and Guiteau, S and Coris, E E},

doi = {10.14423/SMJ.0000000000000340},

year  = {2015},

date = {2015-01-01},

journal = {Southern Medical Journal},

volume = {108},

number = {9},

pages = {553--558},

abstract = {Postconcussive syndrome is an increasingly recognized outcome of sports-related concussion (SRC), characterized by a constellation of poorly defined symptoms. Treatment of PCS is significantly different from that of SRC alone. Primary care physicians often are the first to evaluate these patients, but some are unfamiliar with the available therapeutic approaches. This review provides an overview of the pathophysiology of SRC and descriptions of both pharmacologic and nonpharmacologic treatment options to allow primary care physicians to provide evidence-based care to patients experiencing postconcussive syndrome. © 2015 by The Southern Medical Association.},

keywords = {alternative medicine, Amantadine, antidepressant agent, Antidepressive Agents, anxiety disorder, Article, Athletic Injuries, benzodiazepine derivative, beta adrenergic receptor blocking agent, carbamazepine, cognitive therapy, complication, Concussion, dexamphetamine, diet therapy, disease course, disease severity, Dopamine Agents, dopamine receptor stimulating agent, evidence based medicine, exercise, general practitioner, human, Humans, lamotrigine, Major Depression, METHYLPHENIDATE, monoamine oxidase inhibitor, NEUROCHEMISTRY, neuropsychological test, Pathophysiology, pharmacologic therapy, Physicians, Post-Concussion Syndrome, postconcussion syndrome, Postconcussive syndrome, Primary Care, Primary Health Care, primary medical care, rehabilitation care, rehabilitative therapy, return to sport, sport injury, sports related concussion, symptom, traumatic brain injury, tricyclic antidepressant agent, Vestibular rehabilitation, work resumption},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K

Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.

@article{Ellis2015,

title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},

author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},

doi = {10.3171/2015.1.PEDS14524},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery: Pediatrics},

volume = {16},

number = {3},

pages = {248--255},

abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},

keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},

pubstate = {published},

tppubtype = {article}

}

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

@article{Phillips2015b,

title = {Sports-Related Traumatic Brain Injury},

author = {Phillips, S and Woessner, D},

doi = {10.1016/j.pop.2015.01.010},

year  = {2015},

date = {2015-01-01},

journal = {Primary Care - Clinics in Office Practice},

volume = {42},

number = {2},

pages = {243--248},

abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},

keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Oeur, R A; Karton, C; Post, A; Rousseau, P; Hoshizaki, T B; Marshall, S; Brien, S E; Smith, A; Cusimano, M D; Gilchrist, M D

In: Journal of Neurosurgery, vol. 123, no. 2, pp. 415–422, 2015.

@article{Oeur2015,

title = {A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma},

author = {Oeur, R A and Karton, C and Post, A and Rousseau, P and Hoshizaki, T B and Marshall, S and Brien, S E and Smith, A and Cusimano, M D and Gilchrist, M D},

doi = {10.3171/2014.10.JNS14440},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery},

volume = {123},

number = {2},

pages = {415--422},

abstract = {Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p \< 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p \< 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.},

keywords = {accident, Accident reconstruction, accidental injury, Accidents, Adolescent, adult, Article, Biomechanical Phenomena, Biomechanics, brain, brain concussion, brain stem, brain tissue, Cerebellum, clinical article, comparative study, Concussion, controlled study, Female, finite element analysis, Finite element modelling, gray matter, Hematoma, human, Humans, Hybrid iii headform, injury severity, laboratory test, Male, Mechanical, mechanical stress, middle aged, pathology, Pathophysiology, Persistent postconcussive symptoms, PHYSIOLOGY, Post Hoc Analysis, Post-Concussion Syndrome, postconcussion syndrome, priority journal, shear stress, simulation, SPORTS medicine, STATISTICAL significance, Stress, stress strain relationship, Subdural, subdural hematoma, traumatic brain injury, white matter, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Dessy, A M; Rasouli, J; Choudhri, T F

Second Impact Syndrome: A Rare, Devastating Consequence of Repetitive Head Injuries Journal Article

In: Neurosurgery Quarterly, vol. 25, no. 3, pp. 423–426, 2015.

Vassilyadi, M; Macartney, G; Barrowman, N; Anderson, P; Dube, K

Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study Journal Article

In: Pediatric Neurosurgery, vol. 50, no. 4, pp. 196–203, 2015.

@article{Vassilyadi2015,

title = {Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study},

author = {Vassilyadi, M and Macartney, G and Barrowman, N and Anderson, P and Dube, K},

doi = {10.1159/000431232},

year  = {2015},

date = {2015-01-01},

journal = {Pediatric Neurosurgery},

volume = {50},

number = {4},

pages = {196--203},

abstract = {Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p \< 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities. © 2015 S. Karger AG, Basel.},

keywords = {Adolescent, adult, affect, Article, Athletic Injuries, behavior disorder, brain concussion, Child, clinical article, clinical assessment, cognitive defect, Cognitive Efficiency Index, complication, Concussion, Concussion Symptom Scale, controlled study, Craniocerebral Trauma, Cross-Sectional Studies, cross-sectional study, fatigue, Female, head injury, headache, human, Humans, Immediate Postconcussion Assessment and Cognitive, Likert scale, Male, memory disorder, mild traumatic brain injury, neuropsychological test, noise, Paediatric patients, Pediatric Quality of Life Inventory, postconcussion syndrome, priority journal, psychology, quality of life, rating scale, scoring system, Sport, sport injury, Sports, symptom, time factor, Time Factors, traumatic brain injury, trends},

pubstate = {published},

tppubtype = {article}

}

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W

Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article

In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.

@article{Dematteo2015b,

title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},

author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},

isbn = {01959131},

year  = {2015},

date = {2015-01-01},

journal = {Medicine \& Science in Sports \& Exercise},

volume = {47},

number = {11},

pages = {2283--2290},

abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},

keywords = {*BRAIN -- Concussion, *BRAIN -- Wounds \&amp; injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS},

pubstate = {published},

tppubtype = {article}

}

De Matteo, C; Volterman, K A; Breithaupt, P G; Claridge, E A; Adamich, J; Timmons, B W

Exertion testing in youth with mild traumatic brain injury/concussion Journal Article

In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015.

@article{DeMatteo2015,

title = {Exertion testing in youth with mild traumatic brain injury/concussion},

author = {{De Matteo}, C and Volterman, K A and Breithaupt, P G and Claridge, E A and Adamich, J and Timmons, B W},

doi = {10.1249/MSS.0000000000000682},

year  = {2015},

date = {2015-01-01},

journal = {Medicine \& Science in Sports \& Exercise},

volume = {47},

number = {11},

pages = {2283--2290},

abstract = {Purpose The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. © 2015 by the American College of Sports Medicine.},

keywords = {Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors},

pubstate = {published},

tppubtype = {article}

}

Lucas, S

Posttraumatic Headache: Clinical Characterization and Management Journal Article

In: Current Pain & Headache Reports, vol. 19, no. 10, 2015.

@article{Lucas2015,

title = {Posttraumatic Headache: Clinical Characterization and Management},

author = {Lucas, S},

doi = {10.1007/s11916-015-0520-1},

year  = {2015},

date = {2015-01-01},

journal = {Current Pain \& Headache Reports},

volume = {19},

number = {10},

abstract = {Headache is the most common symptom after traumatic brain injury (TBI). TBI has become a global health concern with an estimated 2.5 million reported TBIs per year in the USA alone. Recent longitudinal studies of posttraumatic headache (PTH) show a high cumulative incidence of 71 % after moderate or severe TBI and an even higher cumulative incidence of 91 % after mild TBI (mTBI) at 1 year after injury. Prevalence remains high at over 44 % throughout the year after moderate or severe TBI and over 54 % after mTBI. A prior history of headache is associated with a higher risk for PTH, whereas older age appears to be protective. Gender does not appear to be a risk factor for PTH. Most PTH has clinical diagnostic criteria meeting that of migraine or probable migraine when primary headache disorder classification criteria are used, followed by tension-type headache. There are no evidence-based treatment guidelines for PTH management; however, expert opinion has suggested treating the PTH using primary headache disorder treatment recommendations according to its type. © 2015, Springer Science+Business Media New York.},

keywords = {amitriptyline, botulinum toxin A, Brain Injuries, chiropractic, clinical feature, complication, Concussion, diagnostic approach route, disease association, disease classification, disease predisposition, drug efficacy, drug induced headache, evidence based medicine, human, Humans, migraine, neuropsychological test, Neuropsychological Tests, nonsteroid antiinflammatory agent, paracetamol, physiotherapy, Post-traumatic headache, postconcussion syndrome, posttraumatic headache, practice guideline, Prevalence, primary headache, Review, risk factor, Risk Factors, SEVERITY of illness index, sports concussion, symptomatology, tension headache, Tension-type headache, topiramate, traumatic brain injury, treatment response, UNITED States, valproate semisodium},

pubstate = {published},

tppubtype = {article}

}

2014

Antonius, D; Mathew, N; Picano, J; Hinds, A; Cogswell, A; Olympia, J; Brooks, T; Di Giacomo, M; Baker, J; Willer, B; Leddy, J

Behavioral health symptoms associated with chronic traumatic encephalopathy: A critical review of the literature and recommendations for treatment and research Journal Article

In: Journal of Neuropsychiatry and Clinical Neurosciences, vol. 26, no. 4, pp. 313–322, 2014.

@article{Antonius2014,

title = {Behavioral health symptoms associated with chronic traumatic encephalopathy: A critical review of the literature and recommendations for treatment and research},

author = {Antonius, D and Mathew, N and Picano, J and Hinds, A and Cogswell, A and Olympia, J and Brooks, T and {Di Giacomo}, M and Baker, J and Willer, B and Leddy, J},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84920996232\&partnerID=40\&md5=cb8a1deab38101900f8d7a8ac0b7a80c},

year  = {2014},

date = {2014-01-01},

journal = {Journal of Neuropsychiatry and Clinical Neurosciences},

volume = {26},

number = {4},

pages = {313--322},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurodegenerative syndrome that has been linked to serious psychiatric symptoms, including depression, aggression, and suicidal behavior. This review critically examines the extant research on the behavioral manifestations of CTE and concludes that the paucity of longitudinal prospective studies on CTE, combined with a lack of research-accepted diagnostic criteria for identifying individuals who are considered at risk for CTE, makes it difficult to reliably establish a causal relationship between CTE and the onset of behavioral health problems. Selection and reporting bias and inconsistency in data collection methods are other concerns. To advance the field, there is a critical need for more empirical research on the behavioral manifestations of CTE. Recommendations and intervention models are also discussed. © 2014 American Psychiatric Association.},

keywords = {Aggression, anxiety disorder, apathy, Article, behavior change, behavior disorder, brain concussion, buspirone, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy beta adrenergic r, cingulate gyrus, degenerative disease, depression, euphoria, head injury, human, hypersexuality, impulse control disorder, mental disease, mental instability, mood change, nerve degeneration, neurofibrillary tangle, olanzapine, parahippocampal gyrus, personality disorder, postconcussion syndrome, posttraumatic stress disorder, priority journal, serotonin uptake inhibitor, sexual behavior, suicidal behavior, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

Jordan, B D

Chronic traumatic encephalopathy and other long-term sequelae Journal Article

In: CONTINUUM Lifelong Learning in Neurology, vol. 20, pp. 1588–1604, 2014.

@article{Jordan2014,

title = {Chronic traumatic encephalopathy and other long-term sequelae},

author = {Jordan, B D},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84927562326\&partnerID=40\&md5=da8cab7e63cee5fa58ae148fa7de9dec},

year  = {2014},

date = {2014-01-01},

journal = {CONTINUUM Lifelong Learning in Neurology},

volume = {20},

pages = {1588--1604},

abstract = {Purpose of Review: Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. Recent Findings: CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. Summary: This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports. © 2014, American Academy of Neurology.},

keywords = {Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury},

pubstate = {published},

tppubtype = {article}

}

2012

Jarvie, Amber

Educate to Prevent: A Look at Concussion Prevention Journal Article

In: UBC Medical Journal, vol. 3, no. 2, pp. 52, 2012, ISBN: 19207425.

Abstract | BibTeX | Tags: BRAIN -- Concussion, BRAIN -- Wounds & injuries, Epilepsy, Physicians -- Training of, postconcussion syndrome

2007

Kerr, J; Swann, I J; Pentland, B

A survey of information given to head-injured patients on direct discharge from emergency departments in Scotland Journal Article

In: Emergency Medicine Journal, vol. 24, no. 5, pp. 330–332, 2007, ISBN: 1472-0205.

Abstract | Links | BibTeX | Tags: adult, Child, Emergency Service, Head Injuries, human, Pamphlets, Patient Discharge Education -- Evaluation, postconcussion syndrome, Scotland

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